SEATTLE JAW SURGERY

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TMJ Ankylosis

Case breakdown

Cutting guides for the ankylosis resection were useful here to allow for proper positioning of the TMJ replacement components. The vertical position of the fossa and the medial/lateral position of the condylar components were very much dependent on accurate vertical and lateral reduction of the ankylosis.
The usual technique of holding the jaw forward with an occlusal splint wouldn’t work here given the poor teeth. To create reproducible anatomy, alveolar custom cutting guides were designed based off of stable landmarks – the nasal floor and chin. Care was taken to keep the cutting guides away from the TMJ replacement surgical sites. Positioning guides importantly engaged the lingual alveolus of the mandible and the palate to resist soft tissue pull. This allowed the joints to be inserted.
The last step in the operation was managing the teeth. Typically we get patients teeth in a second operation but in Nam’s case, we were concerned about monitoring jaw dislocation and rehabbing his mouth closers (masseter, temporalis, pterygoids.) These are typically weak in ankylosis patients. The solution was to create implant supported upper and lower dentures. We created custom implant guides that fit into the same places as the alveolar cutting guides. 10 dental implants were placed with immediate pick up and loading.
Last technical bit that was very useful – islets on the temporary dental appliances for rubber bands. Rubber bands helped Nam learn his occlusion after surgery and were easily removed when they were no longer being used. Surgery took about 14 hours given the complexity involved. We were able to get the patient safely through it and he was up and around the day after. At 6 weeks after surgery, still in his temporaries, he was already able to bite and chew things he remembered from childhood!
The patient’s mandibular advancement was done with bilateral custom TMJ replacement devices. The devices advance the mandible allowing for an increase in upper airway size. In his situation his apneic events dropped from 78 an hour to 19. Typically jaw surgery for sleep apnea involves upper and lower jaw surgery but in his situation, a 2cm lower jaw advancement made a big impact

Condylar Hyperplasia - Mandibular Asymmetry

Condylar hyperplasia is a condition where one side of the jaw joint grows more than the other, causing the jaw to shift and the teeth to meet unevenly over time. In this case, the uneven bite had also led to significant wear on the teeth.
Treatment was planned in two phases: orthodontics first to align the teeth, followed by surgery to correct the jaw. The single surgical operation included upper and lower jaw surgery, a chin procedure (genioplasty), and removal of the overgrown portion of the jaw joint (condylectomy).

Masseter Hypertrophy - Botox Narrowing The Face



Enlarged jaw muscles can develop from habits like clenching and grinding (also called parafunction). While it’s a benign condition, it can cause jaw pain and change your facial shape over time. Botox injections in the masseter can reduce muscle bulk and relieve spasms
 
 
This patient came in with Masseter hypertrophy, which refers to enlarged jaw muscles that can cause jaw pain and change your facial shape over time. Botox can be effective in reducing muscle bulk and relieve spasms.

Surgery First Approach to Correct Bit and Jaw Alignment

 
This patient’s jaw and bite were corrected using a surgery first approach. Rather than waiting to complete orthodontics beforehand, they went into surgery with their braces already in place. The procedure included upper (paramidline osteotomy) and lower jaw surgery (BSSO) to address the midline and symmetry
 
Orthodontics Team: The Smart Orthodontic Group

Rheumatoid Arthritis — Correcting an Anterior Open Bite

This patient developed an anterior open bite over time, meaning his front teeth no longer made contact when his mouth was closed. This gradual change in his bite was linked to a diagnosis of rheumatoid arthritis, which can affect the jaw joints and alter how the teeth meet. Their condition was stabilized through medication before moving forward with surgery.
Treatment included upper (segmental LeFort) and lower jaw  (BSSO) surgery, with the upper jaw divided into segments to precisely fit his front teeth together.
 
Orthodontics Team: Islander Orthodontics

Lower Jaw and Chin Surgery

Diagnosis: Class II Malocclusion and Retrogenia
 
Procedure: Lower jaw surgery (BSSO) and chin (genioplasty) surgery
 
Orthodontics Team: Yousefian Orthodontics

Double Jaw Surgery

Diagnosis: Class III Malocclusion and Mandibular Hyperplasia

Procedure: Upper jaw (Segmental LeFort) and lower Jaw (BSSO) Surgery

 

If you’ve been dealing with chronic jaw tension, teeth grinding, or TMJ-related pain, masseter Botox may have come up as a treatment option. This post walks through the full appointment from start to finish.

A consultation is the appropriate starting point to determine whether this treatment is right for your specific situation.

Why get Botox at an oral and maxillofacial practice?

Botox for jaw pain is not the same as cosmetic Botox. The masseter sits within a complex anatomical environment that includes the jaw joint, surrounding musculature, teeth, and bite. Getting this treatment at a practice that specializes in oral and maxillofacial surgery means your provider understands that full picture before making any recommendations.

At Seattle Jaw Surgery, your visit begins with a clinical evaluation by our PA, Andrea Burgess, PA-C, to understand what is actually driving your jaw pain. From there, she determines the best next step for you specifically. That means:

The visit starts with a clinical evaluation. That way, whatever treatment is recommended is the one that actually makes sense for you, not a one-size-fits-all approach.

For a full overview of what Botox for jaw pain involves and whether it may be appropriate for you, visit our Botox for Jaw Pain service page.

What happens during the appointment?

The procedure typically takes 15 to 30 minutes from start to finish. Here is what to expect:

Clinical evaluation. The appointment begins with Andrea conducting a thorough assessment of jaw function, muscular tension, and joint health. This informs both the treatment recommendation and the injection protocol, including dosing, placement, and whether adjunctive treatment of the temporalis muscle is warranted.

Pre-injection preparation. Prior to injections, an ice pack is applied bilaterally to the masseter to reduce discomfort at the injection sites. This is standard practice at our clinic and does not require topical anesthetic in most cases.

Masseter injections. Four injections are placed into the masseter muscle on each side of the face. Dosing ranges from 35 to 50 units per side, for a total of approximately 100 units across both masseters. Injection placement is determined by palpation of the muscle and findings from the clinical evaluation.

Temporalis injections (if indicated). In patients presenting with tension headaches with a documented jaw muscle component, injection of the temporalis muscle may be performed within the same appointment. This involves 10 to 15 units per side and does not significantly extend procedure time. Andrea will determine whether this is clinically appropriate based on the initial evaluation.

Patients may return to normal activity immediately following the appointment without restriction.

When will you feel a difference?

Botox does not produce immediate results. The muscle relaxes gradually, and most patients begin to notice a difference within two to three weeks of treatment. Results typically last between three and six months, at which point a repeat treatment can be considered.

For patients dealing with ongoing jaw tension, pairing masseter Botox with TMJ physical therapy can be beneficial. A physical therapist who specializes in TMJ dysfunction can help address underlying muscle tension and potentially extend the time between treatments.

Schedule a consultation

To learn more or schedule a consultation with Andrea, contact our office by phone or email. If Botox is the appropriate next step, treatment can often be completed the same day.

[(206) 207-1525] | [info@seattlejawsurgery.com]

For more information on this treatment, visit our Botox for Jaw Pain service page.

Botox is not only used for cosmetic purposes. At Seattle Jaw Surgery, we offer Botox as a clinical treatment for patients experiencing jaw pain, chronic muscle tension, and TMJ-related discomfort. It is sometimes referred to as “Botox for TMJ” because of how commonly it is used to address TMJ-related symptoms.

How it works

The masseter muscle, located on either side of the jaw, is responsible for chewing and clenching. In patients who grind their teeth, clench habitually, or have chronic jaw tension, this muscle can become overactive and enlarged. Over time, the sustained pressure it generates contributes to jaw pain, headaches, and accelerated tooth wear.

Botox injected into the masseter temporarily reduces the activity of the muscle. As it relaxes, patients typically experience a noticeable reduction in jaw tension, pain, and clenching force. For patients with tension headaches originating from the jaw, treatment of the temporalis muscle may also be recommended.

Who performs the treatment

All Botox consultations and treatments at Seattle Jaw Surgery are performed by Andrea Burgess, PA-C. Andrea’s background in oral and maxillofacial surgical care means she approaches this treatment with a detailed understanding of jaw anatomy, muscle function, and the relationship between the masseter and the broader TMJ complex.

Is it right for you?

A consultation is the appropriate first step. At that visit, Andrea will complete a full assessment of your jaw, muscles, and joint function. If Botox is the right fit, treatment can typically be completed the same day. If a different approach would be more effective, you will leave with a clear understanding of your options.

Masseter Botox may be appropriate if you experience:

Benefits

Patients who respond well to masseter Botox typically experience:

Risks

As with any injectable procedure, there are risks to be aware of prior to treatment:

Schedule a consultation

To schedule a TMJ consultation with Andrea Burgess, PA-C, contact our office by phone or email.

[(206) 207-1525] | [info@seattlejawsurgery.com]

For a full walkthrough of the appointment process, visit: What to Expect at Your Masseter Botox Appointment.

Traveling to Seattle for Jaw Surgery (orthognathic surgery), maxillofacial treatment, or total joint replacement treatment? We’ve compiled everything you need to plan a comfortable, stress-free stay in Seattle’s First Hill, from airport arrival through post-surgery recovery. Our board-certified oral and maxillofacial surgeon and treatment care team are here to support you every step of the way.

Getting Here

Seattle-Tacoma International Airport (SEA) is your primary gateway, located approximately 14 miles south of our First Hill office. 

Seattle-Tacoma International Airport (SEA)

The main gateway to Seattle, SEA is a major hub served by most domestic and international carriers. Located in SeaTac, WA — approximately 30–45 minutes by car from our First Hill office depending on traffic. Rideshare, taxi, and rental car services depart from the ground transportation level after baggage claim.

Link Light Rail — Direct from the Airport

The most affordable option: Sound Transit’s 1 Line runs directly from SeaTac Airport to Capitol Hill Station (~38 min, $3.00 fare). From Capitol Hill, the First Hill Streetcar connects directly to our neighborhood. Visit soundtransit.org to plan your trip.

Rideshare (Uber & Lyft)

Uber and Lyft are widely available throughout Seattle and at the airport. Budget approximately $35–$55 for an airport-to-First Hill trip. Please note: you will not be permitted to drive or use unsupervised rideshare following any sedation procedure. A responsible adult companion must accompany you.

First hill streetcar

The First Hill Streetcar Line runs 2.5 miles connecting Capitol Hill, First Hill, the International District, and Pioneer Square. It links directly to the Link Light Rail at Capitol Hill Station. Visit seattle.gov/streetcar.

Accommodations

How long should you plan to stay? 

All patients should plan for a minimum of 1 week in Seattle following surgery to attend their one-week post-operative appointment before traveling home. International patients typically choose to stay for 3 weeks to ensure they are comfortable and cleared for the journey home. If you are planning an extended stay, we recommend exploring alternative lodging options outside the city center — such as extended-stay hotels, furnished apartments, or Airbnb rentals in the greater Seattle area — which can significantly reduce accommodation costs over a multi-week stay.

Silver Cloud Hotel

1100 Broadway
Seattle, WA 98122
P: (206) 325-1400
0.3 miles / 6 min walk

Website Link

Crowne Plaza Seattle-Downtown by IHG

1113 6th Ave
Seattle, WA 98101
P: (206) 464-1980
1.0 miles / 17 min walk

Website Link

Hilton Garden Inn Seattle Downtown

1821 Boren Ave
Seattle, WA 98101
P: (206) 467-7770
1.0 miles / 21 min walk

Website Link

Grocery Store

348s

QFC Broadway

1401 Broadway
Seattle, WA 98122
0.4 miles / 9 min walk

Stockbox first hill

Ninth and Jefferson Building Garage, 901 James St
Seattle, WA 98104
0.3 miles / 7 min walk

Yellow Bee Market & Cafe

922 E Yesler Wy
Seattle, WA 98122
0.5 miles / 11 min walk

Pharmacy

Swedish Pharmacy - First Hill

1221 Madison St, 3rd Floor
Suite 03AR34
Seattle, WA 98104
P: 206-386-6020
Mon – Fri: 9 a.m. – 5 p.m
0.3 miles / 6 min walk

 

A pharmacist-on-call is available 24 hours a day/7 days a week for any question you may have, including emergency and clinical situations such as concerns about side effects, medication assistance and complaint resolution.

Additional Resources

We’ve put together a set of patient resources to help you feel informed and prepared every step of the way.

Do you bill medical insurance?

Yes, we bill medical insurance as an out of network provider. We have a dedicated billing team that advocates on our patient’s behalf to get claims processed. Learn more.

I’m planning from out of state, can my consultation be done virtually?

Due to provider licensing, we must see you in person for initial consultation to establish you as a patient. Throughout your treatment journey we can arrange telehealth visits. Read more about what to expect at your initial consultation.

Video Explanations (TMJ)

Video Explanations (Jaw Surgery)

Video Explanations (Financial Process)

If you’re considering jaw surgery (orthognathic surgery), your first consultation is an important step in your treatment journey. At Seattle Jaw Surgery, we want you to feel informed and comfortable throughout the entire process. Here’s what you can expect when you arrive for your initial consultation.

Scheduling Your Consultation

Whether you’ve been referred by your dentist or orthodontist, or you’re reaching out to us directly, our team is here to help you get started. Once you contact our office or we receive your referral, we’ll schedule your initial consultation at a time that works for you. We’ll also send you our New Patient Packet with important information about your upcoming appointment and request any recent records from your referring provider. Our consultation includes a complimentary Cone Beam CT Scan.

Before You Arrive: Complete Your Online Registration

 To help make your check-in process quick and seamless, please complete your online registration form before your appointment.

 

You can access the registration form in two ways:

 

  • Via text message – You’ll receive a text with a direct link to the form on your phone
  • Through our website – You can find the registration form on our website form

Completing this form ahead of time saves you time in the waiting room and allows our team to prepare for your visit. The form will ask for your personal information, medical history, insurance details, and other important information we’ll need for your consultation.

 

What To Bring To Your Appointment

Even if you’ve completed the online registration, please remember to bring:

  • Your photo ID
  • Insurance cards (both dental and medical)
  • History of any previous surgeries
  • Any questions or concerns you’d like to discuss
  • Copies of related chart notes or imaging

When You Arrive: The Check-In Process

When you arrive at our office, our front desk team will greet you and guide you through a few important steps:

 

Verifying Your Information

We’ll verify your ID and insurance cards, scanning these documents into our system. We’ll confirm that all information in our records is correct.

 

Reviewing Your Forms

If you completed the online registration, we’ll just verify that we have everything we need. If you haven’t had a chance to complete it yet, we can help you finish the paperwork in our office.

 

Financial Discussion

Any payments due will be collected by our team before your consultation.  We are out of network with medical insurance plans and encourage you to contact your insurance carrier to verify out of network coverage. If your insurance plan has out of network benefits, we will collect $253 (50% of the consultation fee) at time of service.  If you have no out-of-network benefits you will become a cash pay patient and we will collect the consultation fee of $506 at time of service. We have a dedicated billing team that helps advocate for our patients to get claims paid and we navigate the billing process on your behalf.

Meeting with Our Dental Assistant

Once you’re checked in, one of our dental assistants will bring you back to the consultation room. Before the surgeon joins you, the dental assistant will:

 

  • Review your medical history with you to ensure we have accurate and complete information
  • Take clinical photographs and/ or imaging if applicable to your case
* Our consultation includes a complimentary Cone Beam CT Scan
 

These photos are an important part of your records and help with treatment planning. The dental assistant will make sure you’re comfortable and prepared before Dr. Bobek arrives.

During Your Consultation With The Surgeon

During this time, Dr. Bobek will:

  • Review your medical and dental history
  • Discuss your concerns and treatment goals
  • Perform a thorough clinical examination
  • Review any imaging or records you’ve provided
  • Explain potential treatment options
  • Discuss the surgical process, timeline, and what to expect

This is your opportunity to ask questions and get a clear understanding of your treatment path. We encourage you to bring a list of questions or concerns you’d like to address.

After Your Consultation: Meeting Our Treatment/ Billing Coordinator

Immediately following your consultation with Dr. Bobek, you’ll meet with our Treatment Coordinator. At Seattle Jaw Surgery, we value patient access to care and price transparency, and our goal is to help you feel supported in every aspect of your care, including navigating through financial planning.

 

During this meeting, our Treatment Coordinator will:

  • Discuss the estimated costs of your specific treatment plan
  • Explain the pre-authorization procedures
  • Answer any questions you may have about the financial aspects of your care
  • Provide information about payment options

Our Treatment Coordinator will be available to support you with any questions you may have, from consultation through post-surgical care. They are your dedicated resource for understanding the financial and administrative aspects of your treatment journey.

The Road Ahead

The jaw surgery process typically involves a waiting period of 6-18 months between your initial consultation and surgery. During this time, you may need to complete pre-surgical orthodontic treatment, obtain insurance authorization, and complete pre-operative appointments.

Throughout this journey, our team at Seattle Jaw Surgery is here to support you. We’re committed to clear communication, comprehensive care, and helping you achieve the functional and aesthetic results you’re looking for.

Questions?

If you have questions before your consultation or would like to schedule an appointment, please don’t hesitate to contact our office at (206) 207-1525.

Helping other professionals understand surgery

We have over the years partnered with many providers – orthodontists, oral surgeons, dentists, physical therapists, endodontists, ENTs, sleep physicians, prosthodontists, oral medicine doctors, and others. There are many misconceptions in regards to surgery and the typical perioperative course. We have been recording topics of interest to other providers to address these issues that can come up. The podcast is called Downfracture and we are partnering with Arizona Jaw Surgery to bring weekly episodes that you might find interesting. Look for new weekly content for additional information.

Here is the link

Spotify